Wednesday, July 15, 2009

1989: Two fatally injured patients and a doctor's lame excuses

Thirty-four-year-old Debra M. Gray went to Hillview Women's Medical Center for a safe and legal abortion on July 8, 1989. She went through their conseling procedure and underwent lab work.

Debra returned for the actual procedure on July 12. An ultrasound was performed and she was estimated to be 16.5 weeks pregnant. Debra signed an undated consent form for the abortion and anesthesia.

The records don't indicate who initiated IV Brevitol for anesthesia, nor do they document the dosage or concentration, nor Debra's weight or the amount of fluid given. There was also no record of a physical exam or any exam to determine if Debra was an appropriate candidate for this type of anesthesia.

The abortionist, Gideon Kioko, indicated that the nurse and other staff expected the drug to induce "twilight sleep" rather than general anesthesia. There was no anesthesiologisst on duty, and no physician supervising the administration of anesthesia medication.

Kioko initiated the abortion. There was no documentation of the effect of the medication, nor of Debra's vital signs. A hospital note indicated that Debra had "responded rather rapidly to the anesthesia" and that three minutes after Kioko had started the abortion, Debra's blood was noted to be "very dark" and she was having trouble breathing. Kioko spent five minutes completing the abortion.

A code note dated July 12, 1989, by a Dr. Raymond Taylor, indicates that Debra was unresponsive, with a low blood pressure and sluggish pulse. Dr. Taylor's note indicated that after fifteen minutes of CPR and advanced cardiac life support, Debra was transported by ambulance to the hospital.

When paramedics arrived, they estimated that Debra's brain had been deprived of oxygen for twelve minutes. Debra had a racing heart, then went into ventricular fibrillation. She was resuscitated, but never regained consciousness. She was pronounced dead on July 15.

The autopsy found traces of heroin in Debra's bloodstream. There was no evidence that the facility had screened Debra for possible drug use.

Hillview staff also allowed Suzanne Logan to suffer an eventually fatal lack of oxygen during an abortion that same year. Suzanne languished in a nursing home for three years before her death.

Kioko made the following excuses to the medical board regarding the fatal abortions:

In the first two cases where Brevital was given, I did not give it, nor did I consent to it. I was not consulted or asked about it. I did not even start intravenous fluids. The decision to administer Brevital was made by the patient and the clinic, and during those [sic] time, I would be called in. I would be notified that "the patient is now asleep, Doctor. You may start the procedure." ....

I, therefore, had nothing to do with the Brevital administered to these two patients. Other contract physicians were also working under similar terms, and, like me, they had nothing to do with the administration of Brevital. I suppose that I was just unlucky at that time and happened to be there when this incident happened.

....

[Regarding Debra Gray]. I understand that [the Brevital] was given by Dr. Barbara Lofton-Clinical Practitioner. My initial contact with the patient was the initial sizing evaulation and to determine the gestational age of the pregnancy. The next contact by me was when the patient was already asleep. As I was finishing the procedure, I called the attention to the administers [sic] of the anesthetic, that the patient's blood was getting unusually dark. At that time, in my view, adequate resuscitation efforts was [sic] immediately instituted with airway established and 911 was called. EKG and oxygen were available and were used. Dr. Taylor, a Cardiology fellow headed the resuscitation effort. It is just not true that adequate resuscitation was not done and that the equipment was not available. Indicenttally, this patient had recently used Opium [sic], though the patient had denied this in her medical history.

The case of [Suzanne Logan] is similar. The patient was put to sleep, with Brevital. I was not in the Operating Room at the time. Once again I was called in to do the procedure once the patient was deemed asleep. I was not consulted, nor did I participate in the decision to give the agent, but once again, I know there was immediate and adequate resuscitation effort. (Please refer to the letter from Dr. [sic] Barbara Lofton). The only case I directly had complete responsibility for is that of ... [Patient C].

The medical board noted that Kioko, as the physician performing the procedure, was still responsible for ensuring that the patient was being provided with appropriate care, regardless of how the clinic chose to assign tasks. The board also noted that nobody was monitoring either woman's vital signs while Kioko was operating on them.

The board noted that "In the above cases, [Kioko] performed surgical procedures under conditions that failed to meet appropriate standards for the delivery of quality medical and surgical care. .... In the event that [Kioko} was unable to correct these conditions, the appropriate standard of care required that [he] not perform these procedures at this facility until these conditions were so corrected."

The board also noted that "Kioko demonstrated a serious lack of judgment.... Kioko assumed that his role was limited to performing technical procedures upon anesthetized patients, leaving overall management of the patients to others. Dr. Kioko's gullibility in this regard proved fatal."

Debra's sister, Tam, who had known her sister was going to Hillview that day and had been planning on meeting her for dinner that night, told 60 Minutes, "It's sad to think that people can go in and have a safe procedure, what they think is safe, and die. The outcome was just like a back-alley abortion."

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